Eating disorders vs. disordered eating — what's the difference, and how to get help
“I had an eating disorder early in my life. I was 11, 12 when I was diagnosed with my first eating disorder,” says Anne Poirier, author of The Body Joyful and someone who today, at 59, has struggled with her disorder for most of her life. “I just had a mother that was relentless and knew something was wrong and took me kicking and screaming to a therapist. I ended up in the hospital.”
That was lucky for Poirier, as eating disorders weren’t openly discussed much in the 1970s. Still, she tells Yahoo Life, ”rules around food, secrecy of food, hiding exercise, weighing myself a lot and body checking” were all patterns that she displayed through her disordered eating as a young girl. And without even being aware of it, things began to take a turn.
"One of the hardest things about falling into an eating disorder is, in the beginning, when things get started with disordered eating you get lots of compliments and people are noticing. So you’re feeling kind of validated for what you’re doing, and I think that’s one of the biggest traps, because it’s a reward cycle,” recalls Poirier, who regularly shares her story as part of the Lived Experience Task Force of the National Eating Disorders Association (NEDA). “Then all of a sudden, it turns a corner, and sometimes it’s recognized, and sometimes it’s not. Within the person, a lot of times, I don’t think they even realize they’re falling into it until it’s almost too late.”
For her, too late meant a stint in the hospital, where she received a diagnosis of anorexia and was forced to address her behaviors.
“I got well enough to get out, basically,” she says. “I pulled out so that I was functional — still preoccupied with food and body image, but not as much absorbed in it. So my personality came back, if that makes sense.” Even still, 40 years of her life were riddled with relapses into eating disorders and bouts of what’s now known as “disordered eating” — the distinction between which only recently came into focus for Poirier, and is still largely misunderstood by the general population.
Disordered eating vs. eating disorders
With so much attention paid to severe cases of eating disorders like anorexia and bulimia, it’s important to have awareness of even the most subtle symptoms of disordered eating — which can refer to anything from risky dieting behaviors to frequent body-image thoughts — and how they might be precursors to a diagnosable eating disorder.
The distinction between the two is a difficult though necessary one to make, according to Janet Lydecker, professor of psychiatry at the Yale School of Medicine. She points out that because disordered eating is so pervasive and normalized in society, it takes an extra effort to get it recognized as something problematic.
“So many people in our country have disordered eating," she says, noting that it’s not an official diagnosis but a description of unhealthy behavior or behaviors associated with food and body-image concerns. “Just the preoccupation that Americans have with weight, and with weight being part of attractiveness, and a source of power, particularly, but not exclusively for women, there’s a lot of pressure that we all feel in this culture to manipulate our bodies.”
Christine Peat, associate professor of psychiatry at the University of North Carolina and director for the National Center of Excellence for Eating Disorders, says that issues of disordered eating are often minimized because of the lack of a diagnosis. But, she tells Yahoo Life, “even if you are experiencing disordered eating versus a full eating disorder, it doesn’t mean you don’t need help.”
A diagnosable disorder, meanwhile, has a set of distinguished criteria.
“When it gets into a full eating disorder, there’s always some kind of impairment. So it’s either a physical health impairment or it’s extreme distress or something where important aspects of someone’s life are being compromised, like friendships or family relationships or school performance,” Lydecker explains.
In hindsight, Poirier recognizes moments when her life was affected during the more severe bouts of her illness, including a time when her job was at risk, though she didn’t seek out a diagnosis each time.
Lydecker explains that the process of doing so involves an assessment aligning with the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative guide of the American Psychiatric Association. Jessica Taylor, a site director for the Renfrew Center, a residential eating disorder treatment facility, says that analyzing the “frequency, intensity and duration of what the behaviors are” can be considered a cheat sheet to understanding the process.
It’s only through an assessment that an eating disorder is diagnosable and placed into one of a few existing categories.
“Anorexia nervosa is what most people think of when they think of eating disorders. Anorexia is extreme restriction over what someone allows themselves to eat over the course of the day. It’s typically associated with weight loss and it's accompanied by these fears of gaining weight or being fat despite the weight loss and the extreme restriction that’s going on,” Lydecker explains.
Bulimia nervosa is when individuals binge and then purge. After a binge, she says, “they feel that loss of control and feel like they eat too much at that time, and then it’s followed by a purge, so something to get the calories consumed during the binge out of the body. The typical one that most people will recognize is the self-induced vomiting, but it can be many things. It can be using laxatives or diuretics in an inappropriate way, it can be fasting, it can be exercising in an extreme or driven way.”
Where it becomes more complicated, according to Peat, is with binge eating disorder. “That looks just like bulimia, except that there’s no purge after the binge. So it’s characterized by regular binge eating, where it’s happening a lot and individuals are highly distressed by it,” she says.
Additionally, there are behaviors that fall into lesser-known categories listed in the DSM, such as Other Specified Feeding and Eating Disorders, or OSFED, and Avoiding Restrictive Food Intake Disorder, or ARFID.
Stigmas and stereotypes
Perceived ideas of eating disorders are “one of the biggest barriers that we see in terms of people getting access to care,” according to Peat.
“People certainly still assume that it’s a food issue,” Lydecker says. She points to the assumption that a person’s motivation behind an eating disorder might be vanity, having only to do with their appearance and then letting it overtake their lives — when in fact it’s a mental health disorder.
Still, the physicality is what makes such disorders more difficult to grasp.
“Eating disorders often carry a greater sort of medical risk than some of the other mental health conditions that are out there. Certainly, that’s not true of all of them. But sometimes, because there’s such a heavy sort of physical component, people forget that they are in fact mental health conditions,” Peat says.
Even while struggling, people might be misled by the mental image that so many still have of those with eating disorders — specifically, white, cisgender women who are privileged and visibly underweight. “It not only affects the ability of people to self-identify with having an eating disorder, but it also affects health care providers,” Peat explains. “And that’s not because they’re not doing their job, or they’re maliciously excluding people. But I think that, you know, we’re only as good as the information that we’re given.”
That’s the very reason that anyone involved in a child or young adult’s life should be aware of what symptoms of an eating disorder might look like, in case the individual doesn’t recognize it themselves. “One of the really pernicious parts of eating disorders is that when individuals have them, they seem to be helpful, they seem to be getting them where they want to go,” Lydecker says. “So it can be hard for the individual with an eating disorder to see some of the the destructive aspects of the disorder.”
Poirier recalls believing "I was doing something good for myself" when engaging in harmful patterns. She often needed "somebody outside of me to let me know that something was going on with me," although she admittedly made it harder by becoming more deceitful.
The stigma that surrounded mental illness at the time of her initial diagnosis in the ’70s made her unwilling to seek that help out again in the future.
“For some people, there can be a sense of relief in having a diagnosis, because it gives them a path forward, it gives them a sense of, OK, this is the condition that I have, these are the treatments that are available for this condition, so this gives me a place to start,” Peat explains. “Some people, though, have talked about feeling penned in by having a specific diagnosis and feeling as though maybe they’re being seen as a diagnosis versus an individual.”
That stigma prevails today, although a diagnosis is needed for proper care.
Care and recovery
“Recovery, just like the actual eating disorder, is going to be highly individual to the person,” Lydecker explains. “Recovery can be long-term, where some recover pretty quickly. And then others will have to go back into treatment several times. Sometimes that’s because treatment wasn’t fully accepted the first time around, it wasn’t exactly what the patient needed. And other times it’s because life is so hard and additional stressors piled up that triggered the eating disorder again.”
This is where it’s helpful to remember that eating disorders are mental health disorders. And while there are different levels of care depending on the severity of the issue, psychotherapy is by and large the most effective — including therapy to prevent disordered eating from becoming a full-blown eating disorder.
“Without treating eating disorders as a mental health issue, you miss that opportunity to connect or even value the thoughts that are going on and the underlying understanding of who an individual is or how they see the world and how the eating disorder factors into that,” Lydecker explains. “Eating disorders have such power over individuals once they’re entrenched, that it really is almost a separate entity that’s controlling them.”
Progress, she adds, starts with behaviors stopping and ultimately addresses issues with body image, emotional regulation and self-worth that are at the core of the problem. And as pervasive as those issues are, awareness and education surrounding eating disorders is vital.
“The negative body image and the negative self-talk is formed early. Those are the places we have to start working through so that it doesn’t take over your life in an external way, with the control of food, and the control of exercise and the purging and the binging, all of that,” Poirier says, noting the importance of Eating Disorders Awareness Week, which ends on Sunday. “It’s an important week to try to continue to push information out there so that people can recognize and they can seek help and not have the stigma around it. To step into getting help for themselves, because it’s not a good way to live.”
If you or someone you know is struggling with an eating disorder, call the National Eating Disorders Association hotline at 1-800-931-2237.
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